alteplase


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alteplase

 [al´tĕ-plās]
a tissue plasminogen activator produced by recombinant DNA technology; used in therapy for acute myocardial infarction, acute ischemic stroke, and acute pulmonary embolism, administered intravenously.

alteplase (tissue plasminogen activator, recombinant)

Actilyse (UK), Activase, Activase rt-PA (CA), Cathflo Activase

Pharmacologic class: Plasminogen activator

Therapeutic class: Thrombolytic

Pregnancy risk category C

Action

Converts plasminogen to plasmin, which in turn breaks down fibrin and fibrinogen, thereby dissolving thrombus

Availability

Injection: 2-mg single-patient vials; 50-mg, 100-mg vials

Indications and dosages

Lysis of thrombi obstructing coronary arteries in acute myocardial infarction (MI)

3-hour infusion-

Adults: 100 mg I.V. over 3 hours as follows: 60 mg over first hour (give 6 to 10 mg as bolus over first 1 to 2 minutes), then 20 mg I.V. over second hour, then 20 mg I.V. over third hour

Adults weighing less than 65 kg (143 lb): 1.25 mg/kg I.V. in divided doses over 3 hours, not to exceed 100 mg Accelerated infusion-

Adults weighing more than 67 kg (147 lb): Give total dosage of 100 mg as follows: 15 mg I.V. bolus over 1 to 2 minutes, then 50 mg I.V. over next 30 minutes, then 35 mg I.V. over next 60 minutes.

Adults weighing 67 kg (147 lb) or less: 15 mg I.V. bolus over 1 to 2 minutes, followed by 0.75 mg/kg I.V. over next 30 minutes (not to exceed 50 mg), followed by 0.5 mg/kg I.V. over next hour, not to exceed 35 mg

Acute ischemic cerebrovascular accident (CVA)

Adults: 0.9 mg/kg I.V. over 1 hour, to a maximum dosage of 90 mg, with 10% of total dosage given as I.V. bolus within first minute

Acute massive pulmonary embolism

Adults: 100 mg I.V. over 2 hours, followed by heparin

Restoration of function of central venous access device

Adults weighing 30 kg (66 lb) or more:Cathflo Activase-2 mg/2-ml concentration instilled in dysfunctional catheter. If catheter function isn't restored in 120 minutes after first dose, may give second dose.

Adults weighing 10 kg (22 lb) to less than 30 kg:Cathflo Activase-Use 110% of catheter lumen volume not to exceed 2 mg/2-ml concentration instilled in dysfunctional catheter. If catheter function isn't restored in 120 minutes after first dose, may give second dose.

Off-label uses

• Small-vessel occlusion by microthrombi
• Peripheral arterial thromboembolism

Contraindications

• Hypersensitivity to drug or its components (Cathflo Activase)
• Seizures, stroke, aneurysm, intracranial neoplasm, bleeding diathesis

Precautions

Use cautiously in:
• hypersensitivity to anistreplase or streptokinase
• GI or genitourinary bleeding, ophthalmic hemorrhage, organ biopsy, severe hepatic or renal disease
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

Be aware that intracranial hemorrhage must be ruled out before therapy begins.

To treat acute ischemic CVA, give within 3 hours of initial signs or symptoms.

If uncontrolled bleeding occurs, stop infusion and notify prescriber immediately.
• Give I.V. only, using controlled-infusion pump.
• Reconstitute with unpreserved sterile water for injection. May be further diluted with normal saline solution or D5W.

Adverse reactions

CNS: cerebral hemorrhage, cerebral edema, CVA (with accelerated infusion)

CV: hypotension, bradycardia, recurrent ischemia, pericardial effusion, pericarditis, mitral regurgitation, electromechanical dissociation, arrhythmias, cardiogenic shock, heart failure, cardiac arrest, cardiac tamponade, myocardial rupture, embolization, venous thrombosis

GI: nausea, vomiting, GI bleeding

GU: GU tract bleeding

Hematologic: spontaneous bleeding, bone marrow depression

Musculoskeletal: musculoskeletal pain

Respiratory: pulmonary edema

Skin: bruising, flushing

Other: fever, edema, phlebitis or bleeding at I.V. site, hypersensitivity reaction (including rash, anaphylactic reaction, laryngeal edema), sepsis

Interactions

Drug-drug.Aspirin, drugs affecting platelet activity (such as abciximab, heparin, dipyridamole, oral anticoagulants, vitamin K antagonists): increased risk of bleeding

Drug-diagnostic tests.Blood urea nitrogen: elevated level

Patient monitoring

• Monitor vital signs, ECG, and neurologic status.
• Maintain strict bed rest.
• Watch for signs and symptoms of bleeding tendency and hemorrhage.
• Monitor patient on Cathflo Activase for GI bleeding, venous thrombosis, and sepsis.
• Evaluate results of clotting studies.

Patient teaching

• As appropriate, explain therapy and monitoring to patient and family.

alteplase

(awl-tĕ-plāz),
A tissue plasminogen activator made by recombinant DNA technology, used as a thrombolytic.

alteplase

/al·te·plase/ (al´tĕ-plās) a tissue plasminogen activator produced by recombinant DNA technology; used in fibrinolytic therapy for acute myocardial infarction and as a thrombolytic in the treatment of acute ischemic stroke and pulmonary embolism.

alteplase

a tissue plasminogen activator.
indications This drug is used for lysis of obstructing thrombi associated with acute MI and for other ischemic conditions requiring thrombolysis.
contraindications Known hypersensitivity to this drug, active internal bleeding, recent cerebrovascular accident, severe uncontrolled hypertension, intracranial trauma or surgery, intraspinal trauma or surgery, aneurysm, and brain tumor prohibit the use of this drug.
adverse effects Adverse effects of this drug include urticaria and rash. Surface bleeding is a common side effect. Life-threatening side effects include sinus bradycardia, ventricular tachycardia, accelerated idioventricular rhythm, bradycardia, GI bleeding, genitourinary bleeding, intracranial bleeding, retroperitoneal bleeding, and anaphylaxis.

alteplase

Activase® Cardiology A thrombolytic used to manage and prevent pulmonary embolism. See Pulmonary embolism, Thrombolytic therapy.

alteplase

A TISSUE PLASMINOGEN ACTIVATOR drug made by recombinant DNA technology. In mid-2003 the drug was approved for the treatment of ischaemic stroke by experts. It must be given within three hours and cerebral haemorrhage must be excluded. A brand name is Actilyse.
References in periodicals archive ?
Our early experience with alteplase has demonstrated that it is an effective alternative to urokinase in catheter-directed thrombolysis for peripheral vascular occlusion; however, it is clear that further investigation is warranted in order to determine its optimal dose.
In the Ontario study--a prospective study of acute stroke patients who received alteplase at a university hospital over 4 years--investigators reported that a lack of improvement at 24 hours was associated with poor outcome and death at 3 months.
20-mg of CT: head (-) for post Alteplase recanalization hemorrhage administered 19:00 N/A Patient transferred to ICU Note.
Alteplase is marketed under the brand name Activase(R) in the U.
Patients coming into the hospital having experiencing a stroke will first be given a brain scan to check there is no bleeding before being given the alteplase intravenously.
The study showed that patients treated with alteplase in this extended time window had a 34 percent improvement in the odds of having a favourable outcome versus placebo (absolute 7.
To settle the question, the researchers undertook a multicenter clinical trial in which 118 patients were randomly assigned to receive conventional heparin plus alteplase and 138 to receive conventional heparin plus a placebo.
More recently in the United States, the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study increased the time window for t-PA administration to 5 hours.
Alteplase is an enzyme that occurs naturally in humans and causes blood clots to dissolve.
Alteplase is an enzyme that occurs naturally in man and causes blood clots to dissolve.
The incidence of symptomatic intracranial hemorrhage (ICH) in patients treated with NXY-059 and alteplase, a tissue plasminogen activator (rt-PA), was lower than in patients treated with placebo and rt-PA (2.